VICENTE SOTTO MEMORIAL MEDICAL CENTER

B. Rodriguez St., Cebu City

NURSING SERVICE DIVISION

Case Study On

ACUTE KIDNEY INJURY SECONDARY TO OBSTRUCTIVE

NEPHROPATHY SECONDARY TO NEPHROLITHIASIS

Marijoy L. Barrio, R.N.

Hemodialysis – Nurse Trainee
February 13 – May 13,2023

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 TABLE OF CONTENTS
Title Page 1
Table Of Contents 2
Abstract 3
Objective of the Case Study 4
Significance Of the Study 5
Methodology
A. Patients Profile 6
B. Nursing History 6
GORDON’S FUNCTIONAL HEALTH PATTERN 7
Course in the Ward 10
Discussion of the Case 15
Pathophysiology 17
Nursing Care Management 20
Conclusion 23
Recommendation 24
Plan of Activity 25
References 28
Appendices
APPENDIX A:
FIGURE 1: Glomerular Filtration Rate Table 29
FIGURE 2: COMPARING TYPES OF AKI 29
APPENDIX B:
FIGURE 1: CONCEPTUAL FRAMEWORK OF ACUTE KIDNEY INJURY 30
FIGURE 2: FOUR PHASES OF AKI 31
Appendix C: Laboratory Reports 32
Appendix D: CT scan of Whole Abdomen 32
Appendix E: Chest X-ray 33
Appendix F: Drug Study 34
Curriculum Vitae 37

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 ABSTRACT
Acute kidney injury secondary to obstructive nephropathy is a frequent event

that accounts for 5 to 10% of all acute kidney injury cases and has a great impact on

the morbidity and mortality in those affected.

The obstruction in the urinary tract has a profound impact on kidney function

due to damage produced by ischemic and inflammatory factors that have been

associated with intense fibrosis. This pathology is characterized by its effects on the

management of fluids, electrolytes, and the acid-base mechanisms by the renal

tubule; consequently, metabolic acidosis, hyperkalemia, uremia, and anuria are seen

during acute kidney injury due to obstructive nephropathy, and after drainage,

polyuria may occur. Acute urine retention is the typical presentation.

This case study focuses on the nursing management of a 55-year-old male,

diagnosed with Acute Kidney Injury Secondary to Obstructive Nephropathy

Secondary to Nephrolithiasis.

Management includes, drainage of the obstructed urinary tract system, providing

supportive treatment, correcting all the metabolic abnormalities, and initiating renal

replacement therapy as required by the medical team.

Recovery in most AKI cases are favorable, it seems to be an undervalued

event in nephrology and urology. This is because it is mistakenly believed that the

resolution and recovery of kidney function is complete once the urinary tract is

unobstructed. It can have serious kidney sequelae.

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OBJECTIVE OF THE CASE STUDY
This case study aims to demonstrate the knowledge regarding the patient’s

health condition, diagnosis, disease process, treatment plan, medical and nursing

interventions.

Specifically:

1. To obtain necessary information regarding the patient and his condition.

2. Define and discuss Acute Kidney Injury and identify its causes, signs and

symptoms.

3. To provide an appropriate nursing intervention to meet the patient’s

identified needs.

4. To provide an action plan raising awareness of Acute Kidney Injury.

This case study uses the three C’s (Care, Core, Cure) management

approach, anchored to the nursing theory of Lydia Hall. According to Lydia Hall’s

Care, Core, Cure Model “Nursing is participation in care, core and cure aspect of

patients care, where Care is the sole function of nurses, whereas the CORE and

CURE are shared with other members of health team. The major purpose of care is

to achieve an interpersonal relationship with the individual that will facilitate the

development of the core”.

In this same thought, we as health providers are called to the responsibility of

promoting health through providing strategic care to patients and actively involved in

the development of the nursing care. The core of the study is that the patient

receives care from nurses, wherein cure, is the attention given to the patient by the

medical professionals such as physicians, nutritionist, surgeons, pharmacist in

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treating the patient. The care is the role of the nurse in providing motherly care,

comfort measures, and health instructions to patient’s significant others towards the

patient.

SIGNIFICANCE OF THE CASE STUDY

Acute Kidney Injury (AKI), previously called acute renal failure (ARF), denotes

a sudden and often reversible reduction in kidney function, as measured by

glomerular filtration rate (GFR) (Appendix A). There is no clear definition of AKI;

however, several different criteria have been used in research studies which inspires

to develop this case study.

This case study will help nurses understand the condition of the patient. This

would also help nurses in identifying the primary needs of the patient with AKI. By

identifying such needs, we will be able to formulate a care plan for the patient that

would address these needs effectively.

Effective management of the needs identified will help the patient recover

faster and maintain a sense of wellness. Furthermore, this case study can be used

as a tool in nursing practice because it provides a better view on the care of patients

with AKI. This study can give a good introduction to the disease process so that an

established nursing action can be quickly utilized. The output of this study, together

with all the gathered information related to the condition, will help members of the

healthcare team to deepen their understanding in the care of a patient with the same

condition.

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METHODOLOGY
A. Patient’s Profile
A case of patient C, 55 years old, Male, Filipino, from Barangay Mabini,

Cebu City was admitted at Vicente Sotto Memorial Medical Center from April

15, 2023 to present.

B. Nursing History

Patient works as a school custodian and lives in a rural area. Patient is

known to have hypertension, is non-compliant with medication, has no history

of diabetes, occasionally drinks alcohol, smokes 4-5 cigarettes per day, and

drinks 1L of water per day. According to the patient's significant other, there is

no family history of his current ailment.

April 14,2023, patient had an onset of an undocumented fever and

headache with pain score of 6/10. Patient took 500mg dose of paracetamol

tablet which offered a temporary relief.

April 15,2023, patient had a recurrence of fever associated with

vomiting of previously ingested food. As per patient’s significant other, the

patient was also disoriented.

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 GORDON’S FUNCTIONAL HEALTH PATTERN

Health perception and health management. Upon initial assessment, patients

significant other stated that the patient was a known hypertensive and non-compliant

to his antihypertensive medications. Patient is an occasional alcoholic drinker,

smokes 4-5 sticks of cigarette per day. No history of illicit drug use. Buys over the

counter medications such as Biogesic, Mefenamic Acid, Solmux, Diatabs and

Loperamide. Not taking any vitamins or supplements. When sick, goes to the

“manghihilot” or just waits for the sickness to heal. After experiencing the recent

signs of his present condition, the family decided to bring him to the hospital. Upon

admission the patient was disoriented to time, place and person and was confused.

Nutrition and metabolism. Patient’s diet includes, rice, meat, fish, and vegetables.

Consumes 1L of water a day. Drinks coffee in the morning and afternoon. As per

patient’s significant other, patient always has a good appetite. Upon admission the

patient weighs 137 lbs., stands 151 cm, with BMI of 29.6 interpreted as overweight.

Patient was on NPO temporarily.

Elimination. Before he was admitted, patient voids 4-5 times per day, his urine color

as per S.O. was dark yellow most of the time. There no burning sensation felt upon

urination. He usually moves his bowel in the morning. With brown formed stool,

without difficulty in defecating. The impression result of his CT scan of whole

abdomen plain, reticular opacities in the visualized right lung suggestive of

inflammatory process. Bilateral, minimal pleural effusion. Cardiomegaly.

Atherosclerosis of the abdominal aorta and both iliac arteries. Right ureterolithiasis

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with mild hydroureteronephrosis. Renal cyst, right. Spondylosis of the thoracolumbar

spine. Upon admission the patient was vomiting with yellowish vomitus and has no

urine output all throughout the 8-hour shift. A foley catheter was inserted to the

patient’s urethra and attached to urobag, draining well with dark reddish urine, with

an output of 100-150ml drained after the shift.

Activity and exercise. Before the patient was admitted, the patient does simple

exercise like stretching of upper and lower extremities, able to bathe himself, helps in

household chores, goes to work, takes a walk to his neighbor’s house. Prior to

admission, patients’ reaction to stimuli was slower, decreased strength, decreased

speed of movement. Limited range of motion.

Cognition and Perception. Patient has no sensory deficits, oriented to people, time

and place, responds to stimuli verbally and physically, but functions has diminished

and the patient became disoriented to time, place and people due to his current

condition. Prior to admission patient has experienced headache with a pain scale of

6/10 and an undocumented fever.

Sleep and rest. Before the patient became sick, he can sleep up to 8hours per

night. With straight hours of sleep. His earliest time in going to sleep is around 9PM.

And would wake up around 5:30 AM. He takes a nap at noon when he is at his

home. He has no difficulties in going to sleep. he does not use any medications to

promote sleep. During admission his was asleep most of the time, and gets

distracted and sleep is interrupted due to administration of medications, and medical

procedures.

Self-perception and self-concept. Before, he manages his minor sickness with

over-the-counter medications without seeking medical assistance. The patient’s

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family is hopeful that the patient will be relieved and treated with his current

condition.

Roles and relationships. Patient J.P.C. is married and with children, he lives with

his wife and children, he is well-supported and loved by his family with close

relationship. During admission, patient J.P.C. is well supported by his family.

Sexuality and reproduction. The patient is married, has children. He has no history

of sexually transmitted disease or any disease affecting the patient’s genitals.

Coping and stress tolerance. Before the patient became sick, he copes-up with his

stress by drinking alcoholic beverages with his close neighbors. Copes up with his

problems by talking to his wife and children to find ways to resolve it together. No

traumatic events experienced as per his wife. The patient was brought to the hospital

by his family to have his condition checked and treated. few days prior to his

admission the patient has been mentioning of seeking for medical assistance.

Values and belief. Patient is a Roman Catholic, has a strong belief in God. He goes

to the church every Sunday to attend the Holy mass. During admission, there are no

restrictions in the medical procedures and interventions done brought by religion.

The admission of the patient did not interfere with any spiritual practices of the

patient.

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COURSE IN THE WARD

Day 1

April 15, 2023 at around 10:20PM, Patient was seen and examined by Dr.

Aguilar at the emergency room of Vicente Sotto Memorial Medical Center, Dr. Aguilar

ordered the following, intravenous fluid of PNSS 1Liter @100cc/hr. The patient was

placed on temporary NPO. Laboratory test ordered by the attending physician was

taken with the following results: elevated BUN – 78mg/dl and CREATININE –

10.59mg/dl, SGOT/AST – 27u/L, PHOSPHUROS – 2.29mg/dl, MAGNESIUM –

1.88mg/dl, SODIUM – 138.10mg/dl, POTASSIUM – 3.42mg/dl, IONIZED CALCIUM

– 1.26mg/dl were in normal range. Medications ordered by Dr. Aguilar were the

following, METOCLOPRAMIDE 10mg IV NOW THEN every 8-hours AS NEEDED

FOR VOMITING, OMEPRAZOLE 40mg IV NOW THEN every 24-hours before

breakfast , PIPERACILLIN + TAZOBACTAM 2.25grams IV every 12-hours (renally

adjusted), NaHCo3 tab, 1 tablet three times a day Per Orem, CaCo3 tab, 1 tablet

three times a day Per Orem, Dr. Aguilar ordered to refer the Patient to General

Surgery for IJ insertion, Patient was also referred to IM-Nephrologist for

hemodialysis. Patient’s vital signs was monitored every 4-hours, intake and output

checked and documented every 8-hours. Patient was for transfer to ward once with

vacancy.

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Day 2

April 16, 2023, the Patient was prepared for CT-scan of whole abdomen with

bowel preparation as ordered by Dr. Aguilar. The impression result of his CT scan of

whole abdomen plain has the following, reticular opacities in the visualized right lung

suggestive of inflammatory process. Bilateral, minimal pleural effusion.

Cardiomegaly. Atherosclerosis of the abdominal aorta and both iliac arteries. Right

ureterolithiasis with mild hydroureteronephrosis. Renal cyst, right. Spondylosis of the

thoracolumbar spine. was seen on the CT-Scan. At 2:15AM Patient went

unconscious and was given NaCo3 220meqs IV bolus as ordered by Dr. Barredo.

Repeat creatinine, and BUN was also ordered and taken, elevated BUN 99mg/dl,

creatinine 12.25mg/dl. After a few hours the patient has regained consciousness and

complained of flank pain, Dr. Barredo ordered to give Tramadol 50mg IVTT with BP

precaution, then every 8-hours as needed for pain.

Day 3

April 17, 2023, Patient was referred to Thoracic, Cardiac and Vascular

Surgery for IJ catheter insertion, but the patient had an episode of respiratory

distress, oxygen saturation level of 91%, and patient had uremic symptoms TCVS

has to postpone the IJ insertion and ordered to refer back for IJ insertion once airway

is secured, Dr. Barredo has assessed the patient’s condition with the following

orders: Give NaHCO3 240meqs IV bolus, patient was on Non-Invasive Ventilator.

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Day 4
April 19,2023 at 8:06AM, Patient was referred to Uro for evaluation ordered by

Dr. Cruz. Dr. Oliva (Urologist) has seen and evaluated the patient with the following

orders: for Nephrostomy, Right at Emergency Department, secure consent, secure

pigtail catheter Fr.10, lidocaine and protime. At 7:30 PM patient was sent to

Emergency Department for Nephrostomy, right. Dr. Oliva performed the procedure.

With nephrostomy attached, the patient was transported back to ward.

On the same day, the patient was referred back to TCVS for IJ insertion, with

IJ catheter in place, Dr. Barredo ordered a STAT HD with the following parameters.

Ultrafiltration Goal – 500cc, Blood Flow Rate – 150, Dialysate Flow Rate – 300,

Duration – 2-hours, Normal Saline Solution flushing, EPO 4,000 “u” post

Hemodialysis.

Day 5

April 20,2023, another STAT Hemodialysis order was made by Dr. Barredo.

He ordered to give the patient a Calcium Guconate 10% 1 ampule, slow IVTT.

Day 6

April 21,2023 at around 3AM, the patient had an episode of seizure, Patient

was given Diazepam 1 ampule IV. Patient was scheduled for HD #2 with the

following parameters: Duration – 2-hours, Blood Flow Rate – 150, Dialysate Flow

Rate – 300, Ultrafiltration Goal – 500ml, Normal Saline Solution flushing 50cc IV

every 15 minutes.

At 10AM of the same day, Dr. Barredo, has seen and examined the patient with the

following findings: bloody secretions on the patient’s mouth, with no epigastric pain,

Dr. Barredo ordered to give Omeprazole 40mg IVTT every 12hours.

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Day 7

April 22,2023, Patient was seen and examined by Dr. Barredo and ordered for

Hemodialysis #3 with the following parameters: Ultrafiltration Goal – 2L, Blood Flow

Rate – 150, Dialysate Flow Rate – 500, Normal Saline Solution flushing, EPO 4,000

“u” Subcutaneous post Hemodialysis.

Day 8

April 23,2023, Dr. Barredo ordered to secure 1 unit of Packed Red Blood Cell

properly screened and crossmatched; transfuse 1 unit of PRBC to run for 4 hours.

Dr. Barredo also ordered to start Meropenem 500mg IVTT every 24-hours. Patient

has positive uremic symptoms as evidenced by a melena. Dr. Alguire has seen and

examined the patient and ordered to go ahead with HD #3 as ordered without blood,

the patient needs to go on Hemodialysis even if non-acidotic, Dr. Alguire also

ordered to check the vital signs and CBG of the patient prior to renal session, she

added to keep the patient in Trendelenburg’s position during the entirety. Dr. Alguire

ordered to give D50W IVTT NOW with the patient’s CBG reads at 111mg/dl. Patient’s

BP-90/60mmHg, Dr. Alguire ordered to start Norepinephrine 20mg + 30cc NSS at 2.6

cc/hr. via infusion pump.

Day 9

April 24,2023 at 11:15AM, Dr. Barredo ordered a uremic diet for the patient

and to facilitate blood transfusion as he previously ordered.

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Day 10

April 25,2023 at 4:09AM, Dr. Batucan ordered for Hemodialysis #4 with the

following parameters:

Ultrafiltration Goal – 2-3Liters as tolerated, Blood Flow Rate – 250, Dialysate

Flow Rate – 500, reuse dialyzer, Normal Saline Solution flushing, EPO 8,000

“u” subcutaneous post HD. Dr. Batucan added on her order, to secure 2 units

of PRBC of patients’ blood type, properly screened and crossmatched,

transfuse 1 unit of Packed Red Blood Cell of patient’s blood type during

Hemodialysis.

Day 11

April 26,2023, Dr. Batucan examined the patient, and ordered the following:

intravenous fluid to heplock, on uremic diet, oxygen support to high-flow nasal

cannula.

Day 12

April 28, 2023 at 12:52PM, Dr. Batucan ordered to shift the patient’s oxygen

support to nasal cannula 2-3 Liters Per Minute as needed for dyspnea. Dr. Batucan

ordered to pullout the high-flow nasal cannula from the patient’s bedside, patient is

now for completion of antibiotics as ordered.

Day 13
April 30,2023 at 9:16AM, Dr. Batucan ordered for hemodialysis with the
following parameters:

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Ultrafiltration Goal – 2Liters as tolerated, Blood Flow Rate – 200, Dialysate Flow

Rate – 500, reuse dialyzer, to give low dose of heparin flushing, EPO 8,000 “u”

subcutaneous post hemodialysis.

DISCUSSION OF THE CASE

A case of 55-year-old, male, was brought to the Emergency Department of

Vicente Sotto Memorial Medical Center. A day prior, patient had an undocumented

fever and headache. On the day of his admission, he had a recurrence of fever

associated with vomiting of previously ingested food. The patient appeared

disoriented and confused upon assessment.

The patient was diagnosed with Acute Kidney Injury Secondary to Obstructive

Nephropathy Secondary to Nephrolithiasis based on the results of the initial

diagnostic procedure.

Healthy kidneys do many important jobs. They keep our whole body in

balance by removing waste products and extra fluids from our body, helps in

producing healthy red blood cells, and helps control our blood pressure.

Acute kidney injury, also known as acute renal failure, is a sudden episode of

kidney failure or kidney damage that happens within a few hours or a few days. AKI

causes a build-up of waste products in your blood and makes it hard for your kidneys

to keep the right balance of fluid in your body. AKI can also affect other organs such

as the brain, heart, and lungs.

Treatment of AKI depends on what has caused the injury and how severe is

the damage, treatments may include the need to increase fluid intake if the patient is

dehydrated, antibiotics if the patient has an infection, stop taking certain medications

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until kidney problem has been sorted, and a urinary catheter to drain the bladder if

there is a blockage. The main goal of the healthcare team is to treat what has

caused the kidney injury. Most people with AKI make a full recovery, but some

people go on to develop chronic kidney disease or long-term kidney failure as a

result. In severe cases the patient may need a dialysis; peritoneal and hemodialysis.

Both removes waste products and extra fluid from the blood. Hemodialysis uses an

artificial kidney machine, while the other uses the peritoneal lining.

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PATHOPHYSIOLOGY

Acute Kidney Injury is “a sudden decline in both glomerular and tubular

function, resulting in the failure of the kidneys to excrete nitrogen and waste products

with a corresponding failure to maintain fluid, electrolyte and acid-base balance”. AKI

may be associated with decreased urinary output of less than 30 ml/h. Prerenal

failure may not result in kidney damage with early identification and prompt

treatment. The focus of this discussion will be on prerenal caused by the alteration in

renal systemic vascular resistance ratio as a result of sepsis. (Kosinski 2009).

The normal functions of the kidneys are to filter and excrete wastes and toxins

by regulating fluids, electrolytes, and acid-base balance. The kidneys receive 20% to

25% of cardiac output and the amount of blood that flows through the renal arterioles

depends on renal blood flow. Any alteration in the renal blood flow alters the

glomerular filtration rate (GFR) (Broden, 2009).

The chemical and humoral mediators released during sepsis contribute to a

pro-inflammatory response and systemic vasodilation. The resulting decrease

systemic pressure stimulates the sympathetic nervous system, leading to renal

artery constriction and a decrease in both filtration and excretion.

Systems Assessment

Impairment of renal function affects multiple body systems, making the care

needs of AKI complex and challenging. Ongoing comprehensive assessments are

critical; the caregiver must be attentive to the signs and symptoms of renal disease

as well as complications with other organs and systems. The complexity of ARF

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demonstrates the need for correlating patient characteristics and nursing

competencies in the Synergy Model to obtain optimal outcomes.

Renal

The primary effect of AKI is a decrease in urinary output that leads to fluid

retention and edema. Oliguria is the classic sign with an output of less than 400 ml in

24 hours. The decrease in filtration leads to BUN and creatinine build up in the blood

as the kidney loses its ability to remove waste products. Other lab results that may

be abnormal include metabolic acidosis, hyperkalemia, hyponatremia,

hyperphosphatemia, hypocalcemia, and hypermagnesemia.

Cardiovascular

In general, the fluid volume overload experienced in AKI may lead to

hypertension, pulmonary edema, peripheral edema, and arrhythmias. The kidneys

fail to excrete excess potassium which may lead to the following: muscle weakness,

neuromuscular irritability, bradycardia, heart block, asystole, or other arrhythmias

(Campbell, 2003).

Respiratory

Dyspnea may result from the decrease in oxygenation either from associated

anemia or from fluid volume overload and pulmonary edema associated with AKI.

The dyspnea may be at rest or worsen with exertion. Auscultation of lung field may

reveal crackles.

Hematologic

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 AKI patients are anemic secondary to the impaired RBC production,

hemolysis, bleeding, hemodilution, and decrease RBC survival. Damaged kidneys

produce less erythropoietin to stimulate RBC production and the damaged red blood

cells are not replaced. The decrease in hemoglobin leads to insufficient oxygenation

manifested by dyspnea.

Gastrointestinal

Uremia may cause nausea, vomiting, anorexia, gastric ulcers and colitis

which places the patient at risk for GI bleeding. The increase in urea may also cause

the patient’s breath to smell like foul urine.

Figure 1. Systemic Effects of Kidney Injury

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20
ASSESSMENT DIAGNOSIS GOALS AND NURSING RATIONALE EVALUATION
OBJECTIVES INTERVENTION
Blood pressure: Ineffective Patient will 1. Improve patient’s 1.Norepinephrine is used to Patient was able to
90/60mmgh Tissue present an blood flow: Administer increase and maintain blood demonstrate
Perfusion as alert, and maintain pressure in limited, short- hemodynamic
evidenced by conscious, and Norepinephrine 20mg + term serious health balance as
decreased coherent level 30cc NSS at 2.6 cc/hr. situations. evidenced by: BP –
blood pressure. of via infusion pump as 110/70mmhg.
ASSESSMENT DIAGNOSIS consciousness GOALS AND ordered by theNURSING
Attending RATIONALE EVALUATIO
. OBJECTIVES Physician. INTERVENTIONS N
Objective: Altered Mental 1.After 2 hours of 1.Assess patient’s 1.To provide baseline The patient
1.Confused status related to effective nursing level of comparison with does not
2. Keep patient in 2.Promoted as a way to
2.Lethargic accumulation of intervention, the client consciousness and ongoing assessment appear
Trendelenburg’s increase venous return to
3.Incoherent toxins in the brain. will be calm and report changes in behavior. findings and to detect disoriented
position. the heart, increase cardiac
an improved ability to any improvement or and agitated
output and improve organ
cope with confused 2. Provide the client decline in patient’s after 4th
perfusion.
state. and family caregivers neurologic functions. session of
with information about hemodialysis.
3.Monitor the patient’s 3. Severe hypotension is
2.After 2 weeks of the client’s status. 2. Early discussion
blood pressure. considered a hallmark sign
effective nursing with clients and
of shock.
intervention, the client’s 3. Prepare the patient family members,
neurological status will for dialysis. before the significant
improve and stable. cognitive decline, will
likely allow for a
3.The patient will be better alignment of
able to maintain client wishes and
orientation to time, actual outcomes
date, place, person and
circumstances for 3. Marked
specified period of time. deterioration of
thought processes
may indicate
worsening of
azotemia and
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general condition,
requiring prompt
intervention to regain
homeostasis.
ASSESSMENT NURSING GOALS AND NURSING RATIONALE EVALUATION
DIAGNOSIS OBJECTIVES INTERVENTIONS
Patient’s SO Imbalanced The patient 1. Educate the 1. This will provide Patient and SO
verbalized that the Nutrition: Less will remain patient and SO the patient with a shows
patient is still Than Body free of about appropriate certain measure of understanding to
adjusting to dietary Requirements malnutrition dietary regimens control within his or dietary health
restrictions. related to as evidenced and restrictions. her dietary teachings
dietary by nutritional restrictions. Recent provided.
restrictions to markers and dietary guidelines
reduce electrolytes recommend
nitrogenous within normal controlled and
waste products limits 2.Encourage moderate protein
mouth care intake for patients
before meals. with AKI.

2. Mucous
membranes may be
cracked or dry and
can develop mouth
3.Encourage sores. Clean oral
small frequent hygiene makes
meals. eating more pleasant
and may help with
increasing appetite.

3. Small frequent
meals promote
appetite, provide
nutrients, and reduce
nausea and vomiting
which are common in
patients with AKI.
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23
CONCLUSION
Therefore, the outcomes for patients with AKI depend on the cause of the renal

dysfunction the presence of any underlying kidney disease, and the duration of the

renal dysfunction. AKI is not only a result of one underlying disease condition but of

multiple reasons, from trauma, problems of blood circulation, infection, failure to

function of one organ, blood and fluid loss, and obstruction in the urinary tract.

In the past, it was widely believed that AKI was fully reversible in all patients.

However, in the present in most cases only those who seeks medical management

are able to survive the condition. In more serious cases renal replacement therapy

are needed like, peritoneal dialysis and hemodialysis.

Proper education and awareness on the condition will have a great impact to prevent

Acute Kidney Injury. As simple as making a heathy food choice, getting enough

sleep, and exploring stress-reducing activities are one of the simple steps to avoid

AKI and the development of many other diseases.

Health Promotion and Disease Prevention as defined by the World Health

Organization, “Enables people to increase control over their own health. It covers a

wide range of social and environmental interventions that are designed to benefit

and protect individual people’s health and quality of life by addressing and

preventing the root causes of ill health, not just focusing on treatment and cure.”

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RECOMMENDATION

This case study aims to provide the community a proper health teaching on what is

Acute Kidney Injury. Through health teachings we will be able to raise awareness

regarding the disease, the community especially the people who are at most risk will

be able to prevent, recognize the health issues, and seek support when the problem

arises.

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 PLAN OF ACTIVITY

TITLE: HEALTH EDUCATION: ACUTE KIDNEY INJURY (THE BASICS)

TARGET PARTICIPANTS: RESIDENTS IN A COMMUNITY
TIME ALLOTMENT: 30 MINUTES
GENERAL OBJECTIVES: PREVENTION AND AWARENESS OF ACUTE KIDNEY
INJURY
SPECIFIC OBJECTIVES:
1. Prevention of Acute Kidney Injury in people who are at risk.

2. Raise awareness of Acute Kidney Injury and its complications.

3. Promote early diagnosis and treatment of Acute Kidney Injury.

4. Improve the outcomes of people living with Acute Kidney Injury.

What is Acute Kidney Injury?

Acute kidney injury is when the kidneys suddenly stop working. Normally, the
kidneys filter the blood and remove waste and excess salt and water.
The word "acute" means sudden.

What are the common causes of kidney injury?

 Kidney infection
 Dehydration
 Significant blood loss
 Very low blood pressure
 Contrast dye used for some imaging tests, like CT or MRI scan
 Damage to the filtering parts of the kidneys
 Damage to the tubules in your kidney
 Urinary tract obstruction
 Over-the-counter pain medications
 Prescribed medications, including some blood pressure medications at high
doses, antibiotics, or cancer medications
Who's at risk of acute kidney injury?

You're more likely to get AKI if:

 You're aged 65 or over

 You already have a kidney problem, such as chronic kidney disease

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  You have a long-term disease, such as heart failure, liver disease or diabetes

 You're dehydrated or unable to maintain your fluid intake independently

 You have a blockage in your urinary tract

 You have a severe infection or sepsis

 You're taking certain medicines, including non-steroidal anti-inflammatory

drugs (NSAIDS), such as ibuprofen, or blood pressure medicines

 You're given aminoglycosides – a type of antibiotic that's usually only given in

hospital; these medicines are only likely to increase the risk of AKI if you're
dehydrated or ill

What are the symptoms of acute kidney injury?

Some people do not have any symptoms at first. People who are in the hospital
might learn that they have acute kidney injury after they have blood tests for another
reason.

When people do have symptoms, the symptoms can include:

●Urinating less, or not urinating at all

●Blood in the urine, or urine that is red or brown

●Swelling, especially in the legs or feet

●Vomiting, or not feeling hungry

●Feeling weak, or getting tired easily

●Acting confused, or not acting like themselves

●Seizures – Seizures are waves of abnormal electrical activity in the brain. They can
make people pass out, or move or behave strangely.

●Shortness of breath

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When should I call my doctor or nurse?

Call your doctor or nurse if you have any of the above symptoms. If you are already
in the hospital, let your doctor or nurse know if you have any of these symptoms.

Preventing acute kidney injury.

Those at risk of AKI should be monitored with regular blood tests if they become
unwell or start new medicine.

It's also useful to check how much pee you're passing.

 Any warning signs of AKI, such as vomiting or producing little pee, require
immediate investigation for AKI and treatment.
 People who are dehydrated or at risk of dehydration may need to be given fluids
through a drip.
 Any medicine that seems to be making the problem worse or directly damaging
the kidneys needs to be stopped, at least temporarily.

How to take care of our kidneys.

1. Manage your blood sugar.

2. Manage your blood pressure.

3. Maintain a healthy weight.

4. Eat a heart-healthy diet.

5. Reduce salt intake.

6. Drink enough water.

7. Limit alcohol intake.

8. Don’t smoke.

9. Limit the use of over-the-counter pain medication.

10. Reduce stress.

11. Exercise regularly

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REFERENCES
 https://nursestudy.net/acute-kidney

 https://www.disabled-world.com/health/cancer/kidney

 https://nurseslabs.com/acute-renal-failure

 https://www.ncbi.nlm.nih.gov/books/NBK568593/

 https://www.statpearls.com/articlelibrary/nursingarticle/17169

 https://rn-journal.com/journal-of-nursing/acute-renal-failure

 https://www.nhs.uk/conditions/acute-kidney-injury/

 https://sites.google.com/site/mirandadowding3/client-health-assessment/

marjorie-gordons-11-functional-health-patterns

 https://www.uptodate.com/contents/acute-kidney-injury-the-basics

 https://nursingcrib.com/nursing-notes-reviewer/acute-renal-failure/

 https://cursa.ihmc.us/rid=1PM4D4J1R-N2P7MT-R8/Acute%20Kidney

%20Injury.cmap

 https://www.drugs.com/mtm/ertapenem.html#uses

 https://emcrit.org/ibcc/aki/

 https://www.myamericannurse.com/acute-kidney-injury/

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APPENDICES
APPENDIX A.

FIGURE 1: GLOMERULAR FILTRATION RATE TABLE

FIGURE 2: COMPARING TYPES OF AKI

30
APPENDIX B:
FIGURE 1: CONCEPTUAL FRAMEWORK OF ACUTE KIDNEY INJURY

31
FIGURE 2: FOUR PHASES OF AKI

32
 APPENDIX C: LABORATORY REPORTS
Decreasing levels of WBC was observed in the laboratory reports, as the patient has

been administered with Ertapenem 500mg IVTT every 24-hours (Appendix F).

Decreased RBC, hemoglobin and hematocrit were also seen as a result of renal

damage. Earlier tests for BUN and creatinine reports increasing results. Repeat BUN

and creatine test after the 4th hemodialysis session of the patient reports a decrease

of BUN and creatinine level which suggest a good response from the treatment.

APPENDIX D: CT SCAN OF WHOLE ABDOMEN (APRIL 16,2023)

IMPRESSION:
- RETICULAR OPACITIES IN THE VISUALIZED RIGHT LUNG SUGGESTIVE

OF INFLAMMATORY PROCESS

- BILATERAL MINIMAL PLEURAL EFFUSION

- CARDIOMEGALY

- ATHEROSCLEROSIS OF THE ABDOMINAL AORTA AND BOTH ILIAC

ARTERIES

- RENAL CYST, RIGHT

- SPONDYOSIS OF THE THORACOLUMBAR SPINE

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 APPENDIX E: CHEST X-RAY
IMPRESSION:
- RESOLVED RIGHT PLEURAL EFFUSION

- RESOLVED SUBSEGMENTAL ATELECTASIS, RIGHT LOWER LUNG

- ATHEROSCLEROSIS OF THE THORACIC AORTA

- RIGHT-SIDED INTRAJUGULAR CATHETER IN PLACE

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 APPENDIX F. DRUG STUDY
DRUG DOSAGE AND ROUTE INDICATION NURSING RESPONSIBILITIES
Generic Name: Dosage: 5,000 “u” Epoetin is used to treat severe Assess for signs of adverse effects.
Erythropoietin Route: Subcutaneous post anemia in patients on kidney Monitor blood pressure daily.
Brand Name: hemodialysis dialysis or for those not on dialysis. Monitor hematology weekly.
Epoetin Beta Rotate injection sites. Ensuring that the right medication is
properly drawn up in the correct dose, and administered at
the right time through the right route to the right patient.
DRUG DOSAGE AND ROUTE INDICATION NURSING RESPONSIBILITIES
Generic Name: Dosage: 80mg/tab For the control of serum Advise patient about the likelihood of GI reactions such as
Sevelamer phosphorus in adults and children 6 nausea, vomiting, diarrhea, constipation, indigestion, and
Route: Oral
years of age and older with chronic flatulence. Instruct the patient and SO to take Sevelamer with
Brand Name:
Frequency: 5 times a day kidney disease (CKD) on dialysis. meals and to adhere to prescribed diet. Ensuring that the
Renvela
right medication is properly drawn up in the correct dose, and
administered at the right time through the right route to the
right patient.
DRUG DOSAGE AND ROUTE INDICATION NURSING RESPONSIBILITIES
Generic Name: Dosage: 1 tablet Oral sodium bicarbonate is often Monitor vital signs, laboratory results and level of
Sodium used to correct acid-base consciousness frequently. Watch out for signs of decreasing
Route: Oral
Bicarbonate disturbance in patients with chronic level of consciousness. Record intake and output accurately
Brand Name: Frequency: 3 time a day kidney disease (CKD). to monitor renal function. Ensuring that the right medication is
Alka-Seltzer properly drawn up in the correct dose, and administered at
Heartburn Relief the right time through the right route to the right patient.

DRUG DOSAGE AND ROUTE INDICATION NURSING RESPONSIBILITIES

35
Generic Name: Dosage: 1 tablet Calcium carbonate is used for the Instruct the patient and SO to take calcium carbonate with
Calcium treatment of hyperphosphatemia, food or after meals. Monitor the patient’s urine output.
Route: Oral normalizing phosphate Monitor for signs of swelling, or rapid weight gain. Ensuring
Carbonate
Frequency: 3 time a day concentrations in patients with that the right medication is properly drawn up in the correct
Brand Name: CKD. It can also be used as a dose, and administered at the right time through the right
CALCI AID calcium supplement in these route to the right patient.
patients.
DRUG DOSAGE AND ROUTE INDICATION NURSING RESPONSIBILITIES
Generic Name: Dosage: 10 mg To treat nausea and vomiting in Monitor for signs of drug overdose which includes the
Metoclopramid patients with gastroesophageal following: drowsiness, disorientation, and extrapyramidal
Route: IVTT
e reflux disease or diabetic reactions. Monitor BP carefully during IV administration.
Frequency: Every 8-hours gastroparesis by increasing gastric
Brand Name: Monitor diabetic patients, arrange for alteration in insulin
as needed for vomiting motility.
Plasil dose or timing if diabetic control is compromised by
alterations in timing of food absorption. Ensuring that the
right medication is properly drawn up in the correct dose, and
administered at the right time through the right route to the
right patient.
DRUG DOSAGE AND ROUTE INDICATION NURSING RESPONSIBILITIES
Generic Name: Dosage: 40 mg Treatment of active duodenal ulcer Instruct patient to report bothersome or prolonged side
Omeprazole in adults. Eradication of effects, including skin problems (itching, rash) or GI effects
Route: IVTT (nausea, diarrhea, vomiting, constipation, heartburn,
Helicobacter pylori to reduce the
Brand Name: flatulence, abdominal pain). Administer drug before meals.
Frequency: Every 12- risk of duodenal ulcer recurrence in
Prilosec Ensuring that the right medication is properly drawn up in the
hours adults. Pathologic hypersecretory
conditions in adults. correct dose, and administered at the right time through the
right route to the right patient.

36
 DRUG DOSAGE AND ROUTE INDICATION NURSING RESPONSIBILITIES
Generic Name: Dosage: 500 mg Ertapenem is an antibiotic that is Assess for the mentioned cautions and contraindications
Ertapenem used to treat severe infections (e.g. drug allergies, CNS depression, CV disorders, etc.) to
Route: IVTT caused by bacteria in the skin, prevent any untoward complications. Perform a thorough
Brand Name: lungs, stomach, pelvis, and urinary physical assessment (other medications taken, CNS, skin,
Frequency: Every 24
Invanz tract. Infections caused by respirations, and laboratory tests like renal functions tests
hours
susceptible strains: Pseudomonas and complete blood count or CBC) to establish baseline data
aeruginosa, Escherichia coli, before drug therapy begins, to determine effectiveness of
Proteus spp., Klebsiella- therapy, and to evaluate for occurrence of any adverse
Enterobacter-Serratia group, effects associated with drug therapy. Perform culture and
Citrobacter spp., and sensitivity tests at the site of infection to ensure appropriate
Staphylococcus spp. use of the drug. Conduct orientation and reflex assessment,
Serious infections susceptible to as well as auditory testing to evaluate any CNS effects of the
penicillin when penicillin is drug (aminoglycosides).
contraindicated.
DRUG DOSAGE AND ROUTE INDICATION NURSING RESPONSIBILITIES
Generic Name: Dosage: 20 mg + 30 cc Blood pressure control in certain Monitor blood pressure and apical pulse continuously during
Norepinephrine NSS acute hypotensive states. norepinephrine therapy.
Blood pressure should be monitored carefully for the duration
Brand Name: Route: Intravenous of therapy, and preferably controlled by arterial blood
Levophed Infusion pressure monitoring.

37
 C. CURRICULUM VITAE
MARIJOY L. BARRIO, R.N.
Guisok, Tuburan Sur, Danao City Cebu
E-mail: marijoy.barrio@gmail.com
Mobile No: (+63)9668532329

OBJECTIVE
Aiming to secure the position of Dialysis Nurse where I can use my technical skills,
clinical judgment, and problem-solving abilities. To bring my commitment to
excellence, dedication, and enthusiasm as a Dialysis Nurse while providing
compassionate care to patients.
SUMMARY OF QUALIFICATIONS
 Graduate of University of Cebu – Banilad with a degree of Bachelor of
Science in Nursing
 Registered Nurse
 Physically and mentally fit to work.
 Observes policies and maintains punctuality at all times.
 Compassionate, hardworking and can work with minima supervision.
 With the ability to adapt the working environment easily.
PERSONAL DATA
Age: 33 years old
Birthday: March 22,1990
Birthplace: Danao City, Cebu
Weight: 58kg
Height: 5’2”
Status: Single
Religion: Roman Catholic
Gender: Female
Nationality: Filipino
LANGUAGES
Cebuano, Filipino, English

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EDUCATION
TERTIARY EDUCATION
 Bachelor of Science in Nursing 2006 – 2010
University of Cebu – Banilad
Banilad, Cebu City
SECONDARY EDUCATION
 Sto. Tomas School (Sto. Tomas College – Danao)
2002 – 2006
Danao City, Cebu
ELEMENTARY EDUCATION
 Danao City Central School
1996 – 2002
Danao City, Cebu
GOVERNMENT EXAMINATION TAKEN AND PASSED
 Philippine Nurses Licensure Exam – December 2010
TRAININGS AND SEMINARS ATTENDED
 BASIC LIFE SUPPORT
December 2022
Cebu Provincial Hospital – Danao
 MEDICINE ADMINISTRATION
December 2019
Cebu Provincial Hospital – Danao
 BASIC LIFE SUPPORT TRAINING OF TRAINERS (BLS TOT)
January 11 – 13, 2015
Danao City Civic Center, Población, Danao City, Cebu
 EMERGENCY MEDICAL SERVICES TRAINING
August 03 – 12, 2014
Danao City Civic Center, Población, Danao City, Cebu

WORKING EXPERIENCE
 Cebu Provincial Hospital – Danao
Staff Nurse (Medical Ward Nurse)
November 16,2021 – Present

39
Medical Ward Nurse
 Provides nursing care according to plan and undertakes clinical practice
procedures and skills in a competent and safe way.
 Prepare and administer medications.
 Carry physician’s order.
 Monitor and record vital signs of patients
 Ensures documentation in current, accurate, timely and maintains
confidentiality of patients’ data.
 Performs IV insertion.
 Initiates and maintains intravenous therapy as ordered by the physician.
REFERENCES
Mr. Lawrence Nuñez, R.N.
Assistant Chief Nurse
Cebu Provincial Hospital – Danao
Mobile No: (+63)9919374172

Mr. Erwin Joseph Taneo, R.N.

Chief Nurse
Cebu Provincial Hospital – Danao
Mobile No: (+63)9178912660

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